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ALCOHOLIC  PSYCHOSES 
BEFORE  AND  AFTER  PROHIBITION 


-BY- 

HORATIO  M.  POLLOCK,  Ph.  D. 

Statistician  and  Editor,  New  York  State  Hospital  Commission 
Albany,  N.  Y. 


Reprinted  from  “THE  STATE  HOSPITAL  QUARTERLY,”  November,  1922 


iy 


4i 


<fe. 


UTICA,  N.  Y. 

STATE  HOSPITALS  PRESS 
1922 


Return  this  book  on  or  before  the 
Latest  Date  stamped  below.  A 
charge  is  made  on  all  overdue 
books. 

University  of  Illinois  Library 


HUY  10  1944 


. 


FEB  -5  I94F 


■**  ^ *, 

JUH  -2  S350 


27214 


G i G * % l#  \ 


ALCOHOLIC  PSYCHOSES  BEFORE  AND  AFTER 
PROHIBITION 

BY  HORATIO  M.  POLLOCK,  PH.  D., 

STATISTICIAN  AND  EDITOR,  NEW  YORK  STATE  HOSPITAL  COMMISSION 

The  only  nation-wide  information  concerning  alcoholic 
psychoses  among  admissions  to  institutions  for  mental  dis- 
ease available  prior  to  1919  is  that  contained  in  the  Federal 
Census  report  on  the  insane  in  hospitals  in  1910.  On  the 
schedules  that  were  filled  out  for  admissions  during  that 
year,  the  question  was  asked  whether  the  patient  was  suffer- 
ing from  alcoholic  psychosis.  The  term  “alcoholic  psy- 
chosis’ * was  defined  in  the  instructions  for  filling  out  the 
schedules  as  follows:  “By  ‘alcoholic  psychosis’  is  meant 
one  of  the  mental  diseases  which,  by  their  characteristic 
symptoms,  are  known  to  be  the  direct  result  of  alcoholic 
intemperance.  Cases  of  mental  disease  in  which  alcoholic 
intemperance  is  only  one  of  the  etiological  factors  and  cases 
merely  associated  with  alcoholic  intemperance  should  not 
be  reported  under  alcoholic  psychosis.  ’ ’ 

Of  the  60,769  patients  with  mental  disease  admitted  to 
institutions  in  1910,  6,122,  or  10.1  per  cent,  were  reported 
to  be  cases  of  alcoholic  psychosis.  The  annual  rate  of  ad- 
mission of  alcoholic  cases  was  6.7  per  100,000  of  the  general 
population.  Considerable  variation  in  rates  was  found  in 
the  several  census  divisions. 

Table  1.  Alcoholic  Cases  Among  Admissions  to  Institutions 
for  Mental  Disease  in  the  Several  Census  Divisions,  1910 


Division  of 

Per  Cent  of 

Rate  per  100,000 

United  States 

Total  Admitted 

of  Population 

New  England  

13.7 

Middle  Atlantic 

11.0 

8.4 

East  North  Central  

10.0 

7.2 

West  North  Central 

7.8 

5.0 

South  Atlantic  

8.0 

4.4 

East  South  Central 

7.3 

3.2 

West  South  Central  

8.1 

2.7 

Mountain  

13.9 

8.5 

Pacific  

12.7 

10.5 

Total  

10.1 

6.7 

2 


It  was  found  by  this  census  that  patients  with  alcoholic 
psychoses  constituted  12.4  per  cent  of  admissions  from 
urban  districts  and  6.4  per  cent  from  rural  districts.  The 
rate  per  100,000  of  population  in  urban  communities  was 
10.7  and  in  rural,  2.6. 

Of  the  34,116  males  admitted  in  1910  to  hospitals  for 
mental  disease,  5,220,  or  15.3  per  cent,  had  alcoholic  psy- 
choses. Of  the  26,653  females  admitted,  902,  or  3.4  per  cent, 
were  diagnosed  as  alcoholic.  The  rates  per  100,000  popu- 
lation of  same  sex  were  11.0  and  2.0  respectively. 

The  figures  above  cited  for  the  Middle  Atlantic  Division 
correspond  closely  with  those  compiled  by  the  statistical 
bureau  of  the  New  York  State  Hospital  Commission  for 
the  year  1910. 

In  gathering  data  concerning  admissions,  the  latter 
bureau  separates  first  admissions  from  readmissions,  as  it 
is  believed  that  the  rate  of  first  admissions  constitutes  a 
better  measure  of  the  incidence  of  mental  disease.  The 
yearly  record  of  first  admissions  with  alcoholic  psychoses 
to  the  thirteen  civil  State  hospitals  of  New  York  State  since 
1909  is  as  follows: 

Table  2.  First  Admissions  with  Alcoholic  Psychoses,  Civil 
State  Hospitals  of  Neic  York,  1909-1921 

Per  Cent  of 

Number  Add  First  Admissions 


Year 

Males 

Females 

Total 

Males 

Females 

Total 

1909  

433 

128 

561 

15.6 

5.8 

10.8 

1910  

452 

131 

583 

15.3 

5.0 

10.5 

1911  

444 

147 

591 

14.7 

5.5 

10.4 

1912  

434 

131 

565 

14.4 

4.8 

9.8 

1913  

438 

134 

572 

13.7 

4.7 

9.4 

1914  

348 

116 

464 

10.4 

3.6 

7.4 

1915  

255 

90 

345 

7.8 

3.1 

5.6 

1916*  

215 

82 

297 

8.4 

3.5 

6.1 

1917  

437 

157 

594 

12.1 

4.8 

8.6 

1918  

257 

97 

354 

7.3 

3.0 

5.2 

1919  

204 

65 

269 

5.8 

2.0 

4.0 

1920  

90 

32 

122 

2.7 

1.0 

1.9 

1921  

167 

26 

193 

4.6 

0.8 

2.8 

* Nine  months. 


RATE  PFR  100,000  SAKE'  SEX 


It  will  be  noted  from  Table  2 that  a marked  decline  in 
the  number  of  alcoholic  first  admissions  began  in  1914  and 
became  more  pronounced  in  1915. v In  1916  a slight  change 


in  trend  occurred,  and  in  1917  a decided  reaction  took 
place,  the  number  of  alcoholic  cases  in  that  year  exceeding 
that  of  1913.  In  1918,  1919,  and  1920,  the  number  of  these 
cases  fell  off  rapidly  and  reached  its  lowest  point  in  1920. 


4 


In  1921  the  male  alcoholic  cases  increased,  although  there 
was  a further  reduction  in  female  cases.  Chart  I shows 
graphically  the  rates  for  both  sexes  since  1909,  based 
upon  the  general  population.  These  rates  are  found  in  the 
following  table : 


Table  3.  Rates  of  Alcoholic  First  Admissions  to  the  New 
York  Civil  State  Hospitals  per  100,000  of  the  General 
Population  of  the  State,' 1909-1921 

Ratk  per  100,000  op  General  Population 


Year 

Males 

op  Same  Sex 
Females 

Total 

1909  

9.7 

2.9 

6.3 

1910  

9.9 

2.9 

6.4 

1911  

9.6 

3.2 

6.4 

1912  

9.2 

2.8 

6.0 

1913  

9.2 

2.8 

6.0 

1914  

7.2 

2.4 

4.8 

1915  

5.3 

1.9 

3.6 

1916*  

4.4 

1.7 

4.0 

1917  

8.8 

3.2 

6.0 

1918  

5.1 

1.9 

3.5 

1919  

4.0 

1.3 

2.6 

1920  

1.7 

0.6 

1.2 

1921  

3.2 

0.5 

1.8 

* Nine  months. 


Correlation  of  Alcoholic  Admissions  and  Per  Capita 
Consumption  of  Liquors 

That  the  rate  of  first  admissions  with  alcoholic  psychoses 
is  closely  correlated  with  the  per  capita  consumption  of 
liquors  is  seen  from  a comparison  of  the  following  index 
numbers  computed  from  official  reports  for  the  years  1909 
to  1920: 


5 


Table  4.  Index  Numbers  of  Bates  of  Alcoholic  Psychoses 


and  Per  Capita  Consumption  of  Liquors,  1909  to  1920 

Index  numbers  of  Index  numbers  of 
rates  of  alcoholic  per  capita'  con- 
first  admissions  to  sumption  of 

Year 

New  York  State 
hospitals 

liquors  in 

United  States 

1909  

100 

100 

1910  

102 

104 

1911  

102 

108 

1912  

95 

105 

1913  

95 

108 

1914  

76 

108 

1915  

95 

1916  

63 

93 

1917  

95 

95 

1918  

56 

77 

1919  

41 

44 

1920  

19 

14 

The  coefficient  of  correlation  between  the 

twTo  series  of 

numbers  is  0.875  ±.045. 

It  is  probable  than 

an  even  closer 

correlation  would  have  been  found  had  data  relative  to 


the  per  capita  consumption  of  liquors  in  the  State  of  New 
York  been  available.  (See  Chart  II.) 


Decline  of  Alcoholic  Psychoses  in  Massachusetts 

The  figures  given  above  showing  the  decline  in  alcoholic 
psychoses  in  recent  years  in  New  York  State  are  paralleled 
by  data  compiled  from  the  official  records  of  the  state  of 
Massachusetts  by  Cora  Frances  Stoddard,1  from  whose 
study  the  following  table  is  taken: 


1 Wet  and  Dry  Years  in  a Decade  of  Massachusetts  Public  Records,  by  Cora  Franees 
Stoddard.  The  Scientific  Temperance  Journal,  June,  1922,  Yol.  31,  pp.  1-54. 


0 


INDEX  NUMBERS  OF  FIRST  ADMISSIONS 
WITH  ALCOHOLIC  PSYCHOSES  IN  NEW  YORK 
STATE  AND  PER  CAPITA  CONSUMPTION 
OF  LIQUORS  IN  UNITED  STATES. 

1909  - 1920 


INDEX 

NUMBER 

110 


00  r 


80 


TO 


60 


50  r 


40 


30 


20 


10 


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INDEX 
NUMBER 
110 


100 

90 

80 

70 

60 

50 

40 

30 

20 

19 

14 

10 


1009  1910  1911  1912  1913  1914  1915  1916  1917  1918  1919  1920 

YEARS 


( 

Table  5.  First  Admissions  with  Alcoholic  Psychoses  to 
Massachusetts  State  Hospitals  for  Mental  Disease  and 
McLean  Hospital , 1912-1921 

Alcoholic  First  Admissions 


Per  cent*  of 

Year  Number  total  first  admissions 

1912  301  11.3 

1913  367  11.8 

1914  311  10.4 

1915  299  9.5 

1916  289  9.1 

1917  511  12.3 

1918  304  8.1 

1919  296  7.8 

1920  102  3.6 

1921  151  4.9 


The  number  of  cases  among  all  first  admissions  in  which 
there  is  a record  of  intemperate  use  of  alcohol  shows  a 
corresponding  decline  during  the  same  period  in  both  New 
York  and  Massachusetts.  The  data  for  New  York  State 
are  given  in  Table  6 : 


Table  6.  Intemperate  Use  of  Alcohol  Among  First  Admis- 
sions, New  York  Civil  State  Hospitals,  1909-1921 

Intemperate  Users  of  Alcohol 

Per  cent  of 


Number 

total 

first  admissions 

Year 

Males 

Females 

Total 

Males 

Females 

Total 

1909  

1,229 

369 

1,598 

44.2 

15.1 

28.7 

1910  

1,684* 

488* 

2,172* 

56.9 

28.7 

38.1 

1911  

1,082 

302 

1,384 

35.9 

11.2 

24.3 

1912  

1,097 

273 

1,370 

36.5 

10.0 

23.8 

1913  

1,103 

318 

1,421 

34.6 

11.1 

23.5 

1914  

1,027 

258 

1,285 

30.8 

8.8 

20.5 

1915  

939 

225 

1,164 

28.8 

7.5 

18.7 

1916t  

725 

182 

907 

28.2 

7.8 

18.5 

1917  

1,152 

300 

1,452 

32.0 

9.2 

21.1 

1918  

851 

253 

1,104 

24.1 

7.7 

16.2 

1919  

804 

161 

965 

22.8 

4.9 

14.2 

1920  

684 

119 

803 

20.3 

3.7 

12.2 

1921  

691 

131 

822 

18.9 

4.0 

11.8 

* Includes  moderate  drinkers, 
t Nine  months. 


8 


The  gradual  decline  in  the  excessive  use  of  alcohol  indi- 
cated by  the  above  table  constitutes  good  evidence  that  a 
marked  change  in  the  habits  of  the  general  population  with 
respect  to  the  use  of  alcohol  had  been  taking  place  for 
several  years  prior  to  the  enactment  of  the  Volstead  Law. 
The  change  began  before  the  World  War,  but  was  halted 
by  the  reaction  of  1917.  Later  it  was  accelerated  by  war- 
time restrictions. 

Alcoholic  Admissions  in  1921 

The  following  tables,  compiled  by  Miss  Edith  M.  Furbush, 
Statistician  of  The  National  Committee  for  Mental  Hygiene, 
from  original  standardized  reports  of  state  hospitals,  give 
the  latest  available  data  concerning  the  prevalence  of  alco- 
holic psychoses  in  various  parts  of  the  country: 

Table  7.  Alcoholic  Psychoses  Among  First  Admissions  to 
State  Hospitals  in  Fourteen  States , 1921 

Alcoholic  First  Admissions 


State 

Total  first 
admissions 

Number 

Per  cent 
of  all  first 
admissions 

California  

2,459 

110 

4.5 

Colorado  

457 

4 

0.9 

Maine  

399 

17 

4.3 

Massachusetts  

2,538 

130 

5.1 

New  Hampshire  

260 

12 

4.6 

New  Jersey 

1,301 

28 

2.2 

New  York  

7,104 

210 

3.0 

Ohio  

2,838 

61 

2.1 

Pennsylvania  

1,508 

39 

2.6 

Ehode  Island  

329 

19 

5.8 

South  Carolina  

740 

9 

1.2 

South  Dakota  

193 

1 

0.5 

Vermont  

140 

3 

2.1 

Virginia  

1,315 

24 

1.8 

Total  

21,581 

667 

3.1 

These  representative  data  show  that  only  3.1  per  cent  of 
first  admissions  to  state  hospitals  in  1921  were  cases  of 
alcoholic  psychoses.  Compared  with  figures  previously 
given  from  the  Federal  Census  of  1910  and  the  reports  of 


9 


the  New  York  State  Hospital  Commission,  a marked  general 
decline  in  alcoholic  insanity  is  shown.  This  is  further 
evidenced  by  the  data  of  all  admissions  shown  in  Table  8, 
which  is  on  nearly  the  same  basis  as  the  Federal  Census 
figures : 

Table  8.  Alcoholic  Admissions  to  State  Hospitals  in  Four- 
teen States  Compared  with  All  Admissions  and 
General  Population,  1921 

Rate 

All  Alcoholic  Admissions  per  100,000 


State 

Total 

admissions 

Number 

Per  cent  of 
all  admissions 

of  general 
population 

California  

3,098 

133 

4.3 

3.8 

Colorado  

480 

5 

1.0 

0.5 

Maine  

20 

4.1 

2.6 

Massachusetts  

3,349 

174 

5.2 

4.5 

New  Hampshire 

301 

14 

4.7 

3.2 

New  Jersey  

38 

2.4 

1.2 

New  York  

9,235 

255 

2.8 

2.4 

Ohio  

3,539 

77 

2.2 

1.3 

Pennsylvania  

47 

2.7 

0.5 

Rhode  Island  

413 

24 

5.8 

3.9 

South  Carolina 

938 

10 

1.1 

0.6 

South  Dakota  

256 

1 

0.4 

0.2 

Vermont  

197 

3 

1.5 

0.9 

Virginia  

1,597 

30 

1.9 

1.3 

Total  

27,178 

831 

3.1 

1.9 

It  will  be  noted  that  the  rate  of  admissions  with  alcoholic 
psychoses  in  these  states  was  only  1.9  per  100,000  popula- 
tion, as  compared  to  6.7  for  the  whole  country  in  1910. 
During  the  year  1920,  the  first  year  under  prohibition, 
alcoholic  admissions  to  state  hospitals  were  less  than  in 
1921. 


10 


Table  9.  Prevalence  of  Alcoholic  Psychoses  in  Twenty 
States,  1919-1921 


I 

Number 

of  Alcoholic 
^irst  Admissions 

per 

Rate  of  Alcoholic 

First  Admissions 
100,000  of  Population 

State 

1921 

1920 

1919 

1921 

1920 

1919 

Arizona  

* 

3 

* 

0.9 

Arkansas 

* 

8 

5 

* 

0.5 

0.3 

California  

110 

* 

* 

3.1 

* 

* 

Colorado  

4 

1 

2 

0.4 

0.1 

0.2 

Connecticut  

* 

* 

31 

* 

* 

2.3 

Georgia  

* 

9 

9 

* 

0.3 

0.3 

Iowa  

* 

20 

26 

* 

0.8 

1.1 

Maine  

17 

6 

18 

2 . 2 

0.8 

2.4 

Massachusetts  . . 

130 

91 

295 

3.3 

2.4 

7.8 

Nebraska  

* 

* 

6 

* 

* 

0.5 

New  Hampshire.. 

12 

12 

16 

2.7 

2.7 

3.6 

New  Jersey  .... 

28 

27 

* 

0.9 

0.9 

* 

New'  York 

210 

143 

285 

2.0 

1.4 

2.8 

Ohio  

61 

64 

* 

1.0 

1.1 

* 

Pennsylvania  . . . 

39 

* 

* 

0.4 

* 

* 

Rhode  Island  . . . 

19 

14 

19 

3.1 

2.3 

3.2 

South  Carolina. . . 

9 

5 

6 

0.5 

0.3 

0.4 

South  Dakota .... 

1 

o 

0.2 

0.3 

Vermont  

3 

2 

2 

0.9 

0.6 

0.6 

Virginia  

* Data  not  available. 

24 

21 

30 

1.0 

0.9 

1.3 

Table  9 gives  comparative  data  for  several  states  for  1919, 
1920,  and  1921.  Although  the  table  is  incomplete,  it  shows 
considerable  reduction  in  alcoholic  admissions  in  several 
states  from  1919  to  1920  and  an  increase  from  1920  to  1921. 
The  reaction  in  1921  may  be  due  to  lax  enforcement  of 
liquor  laws  or  perhaps  in  part  to  the  economic  depression. 


11 


Table  10.  Sex  of  First  Admissions  ivith  Alcoholic  Psychoses 
in  Twenty  States , 1919-1921 


1921  1920  1919 


State 

Males 

Females 

Total 

Males 

Females 

Total 

Males 

Females 

Total 

Arizona  

* 

* 

* 

3 

3 

Arkansas  

* 

* 

* 

8 

8 

5 

5 

California  

102 

8 

110 

* 

* 

* 

* 

* 

* 

Colorado  

3 

1 

4 

1 

1 

2 

2 

Connecticut  .... 

* 

* 

* 

* 

* 

* 

27 

4 

31 

Georgia  

* 

* 

* 

8 

1 

9 

9 

9 

Iowa  

* 

* 

* 

20 

20 

25 

1 

26 

Maine  

16 

1 

17 

6 

6 

17 

1 

18 

Massachusetts  . . 

102 

28 

130 

78 

13 

91 

241 

54 

295 

Nebraska  

* 

* 

* 

* 

* 

*5 f 

6 

6 

New  Hampshire 

9 

Q 

12 

12 

12 

15 

1 

16 

Newr  Jersey.  . . . 

25 

3 

28 

25 

2 

27 

* 

* 

* 

New  York  

184 

26 

210 

110 

33 

143 

216 

69 

285 

Ohio  

57 

4 

61 

60 

4 

64 

* 

* 

* 

Pennsylvania  . . 

34 

5 

39 

* 

* 

* 

* 

* 

* 

Rhode  Island  . . 

17 

2 

19 

11 

9 

14 

17 

2 

19 

South  Carolina.. 

9 

9 

5 

5 

6 

6 

South  Dakota . . . 

1 

1 

2 

2 

Vermont  

2 

1 

3 

1 

1 

2 

2 

9 

Virginia  

22 

2 

24 

18 

3 

21 

27 

Q 

30 

* Data  not  available. 

2 See  note,  p.  5. 


Table  10  shows  the  sex  distribution  of  the  alcoholic  first 
admissions  in  the  several  states.  Kelatively  the  decline  in 
female  alcoholic  first  admissions  in  1920  and  1921  was  more 
than  in  male  cases.  These  results  correspond  with  those 
found  by  Miss  Stoddard2  in  her  study  of  the  effects  of  pro- 
hibition among  women.  She  states : 4 4 The  women  have 
apparently  gained  more  than  the  men  under  prohibition, 
perhaps  because  they  are  less  exposed  to  the  bootleggers’ 
blandishments  and  are  less  likely  to  seek  out  the  tribe.  At 
all  events,  the  average  number  of  women  in  all  penal  insti- 
tutions of  Massachusetts  on  September  30,  1920  and  1921, 
the  two  dry  years,  was  the  lowest  of  the  decade,  60  per  cent 
smaller  than  the  wet  years’  average,  while  the  total  prison 
population  on  this  date  had  dropped  52  per  cent. 

44 A decrease  of  practically  one-half  in  the  number  of 


12 


coimnitments  to  the  State  Reformatory  for  Women  in  the 
two  prohibition  years  carries  a stage  farther  the  story,  not 
only  of  the  passing  of  the  alcoholic  women  from  penal  in- 
stitutions, but  also  of  other  women  offenders.” 

Environment  of  Alcoholic  Cases 

During  the  entire  period  for  which  we  have  adequate 
data,  alcoholic  psychoses  have  been  much  more  prevalent 
in  urban  than  in  rural  districts.  As  previously  mentioned, 
in  1910  the  rates  of  all  alcoholic  admissions  in  the  United 
States  per  100,000  of  general  population  of  the  same  en- 
vironment were  10.7  and  2.6  respectively.  The  admissions 
from  urban  districts  in  that  year  constituted  77.8  per  cent 
of  all  the  alcoholic  admissions.  Since  1910,  the  proportion 
of  alcoholic  cases  from  urban  districts  has  increased.  In 
a study3  of  first  admissions  to  the  New  York  civil  state 
hospitals  from  July  1,  1915,  to  June  30,  1920,  it  was  found 
that  90.9  per  cent  of  the  alcoholic  first  admissions  were 
from  urban  districts.  The  average  annual  rate  per  100,000 
of  general  population  was  3.7  in  urban  districts  and  1.6  in 
rural  districts.  Representative  data  compiled  by  Miss 
Furbush  from  state-hospital  reports  of  several  states  in 
1919,  1920,  and  1921,  show  the  following  percentages: 

Table  11.  Environment  of  First  Admissions  with  Alcoholic 
Psychoses , 1919-1921 

(Representative  data  compiled  from  state-hospital  reports  of  several  states) 


Urbax  Rural 

Year  Number  Per  cent  Number  Per  cent 

1919  333  85.6  56  14.4 

1920  400  83.9  77  16.1 

1921  622  84.4  115  15.6 


As  the  number  and  location  of  the  state  hospitals  report- 
ing were  not  identical  in  the  three  years,  the  above  data  are 
not  strictly  comparable,  but  indicate  clearly  the  preponder- 
ance of  cases  of  alcoholic  psychoses  in  urban  districts. 

3 Mental  Diseuse  in  ('ities,  Villages,  and  Rural  Districts  of  Neio  York,  1915-1920,  by- 
Horatio  M.  Pollock  and  William  J.  Nolan.  State  Hospital  Quarterly,  November,  1921, 
Vol.  7,  pp.  38-65. 


13 


Conclusions 

1.  Marked  reduction  in  the  prevalence  of  alcoholic  psy- 

choses throughout  the  United  States  has  taken  place 
since  1910.  This  is  due  partly  to  restrictions  on 
the  liquor  traffic  and  partly  to  changes  in  the  habits 
of  the  people. 

2 . The  lowest  rate  of  first  admissions  with  alcoholic  psy- 

choses occurred  in  1920;  a reaction  occurred  in  1921. 

3 . The  rate  of  alcoholic  first  admissions  is  closely  corre- 

lated with  the  per  capita  consumption  of  liquors. 

4.  The  reduction  in  the  rate  of  alcoholic  psychoses  has 

been  relatively  greater  among  women  than  among 
men. 

5.  Admissions  with  alcoholic  psychoses  come  principally 

from  urban  districts. 


r 


